| NPI | 1114997830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 017129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32266) |
| 207Q00000X Family Medicine (Licence: NH 15138) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-02-14 |